Turtle Mountain Animal Rescue Spay/Neuter application
Turtle Mountain Animal Rescue will be hosting a spay and neuter event on September 11, 12, 13th organised by 4 Luv of Dog through their SNIP program.
To avoid long lines, we will be choosing pet owners by an application/lottery. (This clinic is not limited to enrolled members of the tribe) To apply you must be a resident of Rolette County and, if selected, will be required to bring a document that proves residency. Elders and low-income individuals will get preference for the first two days of the clinic. The final day will be for everyone else that lives in Rolette county and has completed the application.
The names for the final day will be drawn by lottery at Tribal Headquarters with a witness present. If you do not fill out the entire application, you will not be considered for the lottery so please take the time to fill it all out. All information will be confidential and any applications that have false information will not be considered.
Applicant's Name *
Applicant's Date of Birth *
MM
/
DD
/
YYYY
City you live in *
Phone Number *
Are you employed? *
Approximate annual gross household income *
Name of employer
Number of animals to be neutered/spayed (max of 2) *
Pet 1--species *
Pet 1-Name *
Pet 1-Gender *
Pet 1-Approximate age *
Pet 2--species
Clear selection
Pet 2-Name
Pet 2-Gender
Clear selection
Pet 2-Approximate age
Do you have transportation to get the animal to the Fitness Center in Belcourt? *
Do you have physical limitations that require assistance to get your pet to the clinic? *
If you answered yes to the above question, what are your limitations?
Name of owner: *
My entering my initials below, I am agreeing that all of the information I have provided on this form is accurate and current.
Initials
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy